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- A large, dry, or hard stool
- Frequent diarrhea
- Tightened anal sphincter, a group of muscles that open and close the anus
- Anal irritation
- Pain during and after a bowel movement
- Burning sensation during a bowel movement
- Bleeding with bowel movements that result in bright red blood either on the toilet tissue or in the bowl
- Small amounts of mucous may be present
- Digital rectal exam—to feel for any lumps or abnormalities
- Anoscopy—examination of the anal canal with a scope
- Warm sitz baths, especially after bowel movements, to help relieve pain and promote healing
- Increasing dietary fiber intake
- Increasing fluid intake
- Using stool softeners or bulk laxatives
- Topical medications to reduce pain and inflammation
- Topical nitrates and calcium channel blockers to increase blood flow to the anus and promote healing
- Injected botulinum toxin to relax tightened anal sphincter muscles
- Fissures that do not heal with other treatment methods
- Scar tissue or spasms in the anal sphincter muscles that may also delay healing
- Recurrent fissures
- Lateral internal sphincterotomy—A tiny incision is made in the sphincter muscle fibers to prevent spasms that result in straining during a bowel movement.
- Fissurectomy—Excision of the fissure.
- Anal advancement flap—Covering the fissure with tissue from another part of the body.
- Anal dilation—Rare procedure that widens and stretches the anal canal.
- Drink plenty of fluids throughout the day
- Exercise regularly
- Eat foods high in fiber, such as fruits, vegetables, legumes, and whole grains
- Avoid straining during bowel movements
- Follow your treatment plan if you have Crohn's disease or ulcerative colitis
American College of Gastroenterology http://gi.org
American Society of Colon and Rectal Surgeons http://www.fascrs.org
Canadian Association of Gastroenterology https://www.cag-acg.org
Canadian Society of Colon and Rectal Surgeons http://cscrs.ca
Anal fissure. American Society of Colon & Rectal Surgeons website. Available at: http://www.fascrs.org/patients/disease-condition/anal-fissure. Updated October 2012. Accessed November 9, 2015.
Anal fissure. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113851/Anal-fissure. Updated June 2, 2016. Accessed September 29, 2016.
Fargo M, Latimer K. Evaluation and management of common anorectal conditions. Am Fam Physician. 2012;85(6):624-630.
- Reviewer: Michael Woods, MD
- Review Date: 11/2015 -
- Update Date: 01/28/2015 -